Alone in a valley, surrounded by a forest whose trees were stripped bare by wind, Edgardo Alvarado and Annette Grau sleep on the ground floor of their farmhouse, often going to bed thirsty and hungry.

Puerto Rico: Trump appears to complain about cost of relief effort

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When Hurricane Maria thrashed this municipality in the heart of Puerto Rico two weeks ago it made light work of the couple’s flimsy home. It scattered their belongings on to the muddy ground below, leaving only a single room habitable in their home.

When the sun sets, they live by two dim torchlights as they cannot afford a generator to restore power. The taps no longer work, so they drink water from a nearby stream and bathe in the river. Their crops have been ruined. Their only neighbour has already fled.

When Donald Trump visited Puerto Rico this week, he congratulated local officials, the federal government – and himself – for the official response to the disaster.

“It’s now acknowledged what a great job we’ve done,” Trump said, and told Governor Ricardo Rosselló he could be “very proud” of the low official death toll. Hours after the president jetted back to Washington, the tally doubled to 34 and is expected to rise further.

Trump also told the island, where about 92% of people still have no electricity, that the crisis had thrown the federal budget “a little out of whack”, before tossing paper towels into a crowd of people waiting for basic supplies.

There is no cellular, television, internet or electricity service in Orocovis, but news of the president’s comments had spread here by word of mouth.

“It was like he was making fun of us openly,” Alvarado, 64, said. “He showed complete disrespect.”

“If I was there, I would have thrown the paper back,” Grau, 58, added.

In this remote location, about a 30-minute drive from the municipality’s main town along roads still partially engulfed by landslides, aid has been slow to arrive.

Alvarado received his first relief package – two small boxes of snacks – from troops on Monday, and those meagre supplies have already run out. But there are still some neighbourhoods in this area that have received nothing.

For the first four days after Maria hit, all communications with Orocovis – a municipality of around 23,000 people – were cut, and the main roadway to San Juan was only completely cleared three days ago, finally allowing more aid to flow in.

But the mayor Jesús Colón Berlingeri, said that help was desperately needed.

“We still need help with food, water and communications. It is still very bad.”

The mayor said that five people had died here in circumstances indirectly related to Maria. One 82-year-old man died of a heart attack on the night the hurricane struck. His relatives were unable to remove his corpse from the family home for three days due to blocked roads.

A member of the Puerto Rican national guard dodges downed power cables as he hands out food and water to a neighbourhood in Ceiba, Puerto Rico, on Wednesday. Photograph: Lucas Jackson/Reuters

Some of the minor roadways are still hemmed in by debris – ranging from collapsed pylons, uprooted trees and bamboo to mudslides – meaning some residents are still effectively trapped.

Manuel Maldonado, a 23-year-old now assisting with roadside clearance, said his street had only opened up on Monday, meaning he had been walking five hours a day through the forest to find food for his young family for nine straight days.

“It was like the old times,” he said. “We needed to walk or we would die.”

Although queues for fuel in San Juan have dropped significantly in recent days, and the governor’s office reports 76% of gas stations are now open on the island, there was no petrol at any of Orocovis’s six facilities on Wednesday. At the Saez service station dozens of residents had been queueing since midnight for the next petrol truck to arrive. The last delivery here was on Monday. But by 6pm they were still waiting.

A gas station in downtown Orocovis. Photograph: Oliver Laughland for the Guardian

The municipality’s only hospital was running on a generator that had been in operation since Hurricane Irma struck over a month ago. Staff said it was now only functioning intermittently and the facility had been forced to cut opening hours. Doctors reported a surge in gastroenteritis cases due to people drinking stream water.

At a lookout point high into the mountains residents gather on a daily basis, not to admire the views – now marred by thousands of devastated trees and dozens of destroyed houses – but to try and get a signal on their cellphones. The municipality estimates about 2,000 homes have been destroyed here.

Erica Cartagena, a mother of three, said she had lost the roof of her home when Maria struck and was now living with her sister-in-law who had flown in from New York to bring supplies. Her family had received no government aid and were going hungry on a daily basis.

She was now forced to use unpurified stream water in her eight-month-old son Jonael’s powdered milk.

“I know that it is not good, but what else can I do?” she said. “They [the government] say they’re bringing trucks of water, but I don’t see them anywhere.”

The 28-year-old voiced the exasperation and resentment towards Trump that many articulated here.

“He’s not my president,” she said. “If he was responsible he would have come to the affected areas.”

Her 22-year-old friend Madelina Colón nodded in agreement. She is eight months pregnant and worried: “I’ll have to do it [give birth] like the old times, with no doctor.”

Annette Grau had herself suffered a medical emergency in Maria’s aftermath – a minor heart attack induced by a panic attack after flies and bees swarmed into the house due to flooding. Luckily, she made it to the hospital in time and was given medication to calm the palpitations.

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Eventually on Wednesday the couple received the aid they needed in the short term. A brigade of activists working with an ecological farmers collective drove from San Juan with packets of rice, beans and tinned fruit.

It would be enough to keep them going for a while, but officials estimated that it could take up to a year to restore power to this neighbourhood.